When I first started researching my own Medicare options, I assumed there’d be one “best” choice. There isn’t. There are three real paths — Original Medicare, Original Medicare plus a Medigap policy, or Medicare Advantage — and the right one depends entirely on your health, your budget, and how you like to handle risk.
So I laid out all three side by side, in plain English, so you can see exactly how they differ before you enroll.
The Three Paths, Side by Side
| Original Medicare Only | Original Medicare + Medigap | Medicare Advantage | |
|---|---|---|---|
| Doctor network | Any doctor who accepts Medicare, nationwide | Any doctor who accepts Medicare, nationwide | Usually limited to a plan network (HMO or PPO) |
| Monthly premium | Part B premium only ($202.90 standard in 2026) | Part B premium + separate Medigap premium | Part B premium, often plus a low or $0 plan premium |
| 20% coinsurance | Uncapped — you pay it indefinitely | Mostly or fully covered by Medigap | Replaced by copays, with an annual out-of-pocket cap |
| Annual out-of-pocket cap | None | Effectively capped through Medigap coverage | Yes — set by the plan, up to a CMS-defined maximum |
| Extra benefits (dental, vision, hearing) | Not included | Not included | Often included |
| Prescription drug coverage | Requires separate Part D plan | Requires separate Part D plan | Usually bundled in |
| Referrals needed? | No | No | Often yes, for HMO plans |
Original Medicare: Maximum Freedom, Uncapped Risk
Original Medicare is Part A (hospital coverage) and Part B (outpatient and medical coverage). If you want the full picture of what each part covers, I laid that out in my Medicare basics guide.
The appeal of Original Medicare alone is simple: you can see any doctor, in any state, who accepts Medicare — no networks, no referrals, no prior authorization for most services. That flexibility matters if you split time between two homes, travel often, or already have specialists you don’t want to give up.
The catch is the math. After you meet your Part B deductible, Medicare generally pays 80% of the approved amount for most services, and you pay the remaining 20% — with no annual limit. I walked through exactly what that looks like in dollars, including the 2026 premium, deductible, and IRMAA brackets, in my Medicare Part B cost breakdown. If a serious illness or extended hospital stay hits, that uncapped 20% is the risk Original Medicare alone doesn’t protect you from.
Original Medicare Plus Medigap: Predictable Costs, Extra Premium
A Medigap (Medicare Supplement) policy is private insurance that pairs with Original Medicare and picks up some or all of that 20% coinsurance, along with other gaps like the Part A deductible. In exchange, you pay a separate monthly premium on top of your Part B premium.
Medigap plans are standardized by letter (Plan G and Plan N are two of the most popular right now), so a Plan G from one insurer covers the same things as a Plan G from another — the difference is price and customer service, not benefits. Premiums vary quite a bit by your state, your age, and the insurer, so there isn’t one number I can give you here that would be accurate for your situation. I broke down how the plans differ, how pricing actually works, and the enrollment timing that matters most in my Medigap guide.
The trade-off with Medigap is that you’re paying for predictability. Your monthly costs are higher and more fixed, but a major hospitalization won’t blindside you with uncapped coinsurance. It’s worth noting that Medigap underwriting rules matter a lot here — the best time to enroll is during your six-month Medigap Open Enrollment Period, which starts the month you’re 65 and enrolled in Part B, since insurers generally can’t deny you coverage or charge more for health conditions during that window. Miss it, and you may face medical underwriting later.
Medicare Advantage: Bundled Convenience, Network Limits
Medicare Advantage (Part C) is a different structure entirely. Instead of Original Medicare plus separate supplemental coverage, a private insurer manages your Medicare benefits in one plan — often bundling in Part D drug coverage and extras like dental, vision, and hearing.
The appeal is cost predictability without a big monthly premium. Many Medicare Advantage plans have a $0 premium beyond what you already pay for Part B, and every plan comes with an annual out-of-pocket maximum set by the plan (capped by a CMS-defined limit). Once you hit that cap, the plan covers 100% of covered costs for the rest of the year — something Original Medicare alone never offers.
The trade-off is the network. Most Medicare Advantage plans are HMOs or PPOs, meaning you’re generally limited to doctors and hospitals in the plan’s network, and HMOs often require referrals to see specialists. If you travel frequently, split time between states, or have specific doctors you’re not willing to leave, this is the detail that trips people up most.
A Few Medicare Advantage Wrinkles Worth Knowing
Not all Medicare Advantage plans are the same, even within the same insurer. Networks, extra benefits, and out-of-pocket maximums vary by plan and by county, so the plan your neighbor loves might not even be available where you live, or might cover a completely different set of doctors.
Plans can also change their costs, networks, and benefits from year to year. That’s why Medicare’s Annual Enrollment Period (October 15 through December 7) exists — it’s your yearly window to review your plan and switch if it no longer fits.
How to Think About Which One Fits You
There’s no universal right answer, but a few questions tend to point people in a clear direction:
Do you have specific doctors or specialists you’re not willing to switch? That leans toward Original Medicare, with or without Medigap, since it doesn’t restrict you to a network.
Are you generally healthy and mainly want to keep monthly costs low? Medicare Advantage’s low or $0 premiums can be appealing, as long as you’re comfortable with the network and referral requirements.
Do you have a chronic condition or expect significant medical needs? The uncapped coinsurance under Original Medicare alone is the scenario Medigap exists to solve — worth weighing the extra premium against that risk.
Do you travel often or split time between states? Original Medicare (with or without Medigap) generally travels with you nationwide; most Medicare Advantage plans don’t, outside of emergency care.
Do you want dental, vision, or hearing coverage bundled in? That’s a Medicare Advantage strength — Original Medicare and Medigap don’t include it.
Can You Switch Later?
Yes, but the rules and timing matter. You can generally move between Medicare Advantage and Original Medicare during the Annual Enrollment Period each fall, or Medicare Advantage’s own Open Enrollment Period in the first quarter of the year.
Switching from Medicare Advantage back to Original Medicare and picking up a Medigap policy is the trickier direction. Outside your initial Medigap Open Enrollment Period, insurers can require medical underwriting, meaning they can charge more or deny coverage based on your health. If you think you might want that flexibility later, it’s worth understanding this rule before you enroll in Medicare Advantage in the first place.
Frequently Asked Questions
Is Medicare Advantage cheaper than Original Medicare plus Medigap?
Often, yes, in terms of monthly premiums. But “cheaper” depends on how much care you actually use in a given year, and Medicare Advantage’s network restrictions are a real trade-off, not just a cost question.
Can I have both Medigap and Medicare Advantage?
No. Medigap policies are designed to work with Original Medicare, and it’s against the rules for an insurer to sell you a Medigap policy if you’re enrolled in Medicare Advantage.
Do all Medicare Advantage plans include drug coverage?
Most do, but not all. It’s worth checking a specific plan’s details rather than assuming.
What happens if I move to a different state?
Original Medicare and Medigap coverage travel with you nationwide. Medicare Advantage plans are usually tied to a specific service area, so a move often means switching plans.
Is there a penalty for choosing Medicare Advantage instead of Medigap?
Not a financial penalty, but there can be a practical one: if you switch to Original Medicare later and want a Medigap policy, you may face medical underwriting outside your initial enrollment window.
Where to Go From Here
Understanding your Part B costs is a good starting point no matter which path you choose, since the standard premium applies whether you stick with Original Medicare or add Medicare Advantage on top of it. My 2026 Part B cost guide covers the premium, deductible, and IRMAA brackets in detail, and my IRMAA calculator can show you your estimated premium in a few seconds.
As always — I’m not a financial advisor or licensed insurance agent, just someone working through these decisions myself and sharing what I learn. Coverage choices are personal, and it’s worth a conversation with a licensed Medicare counselor or your local State Health Insurance Assistance Program (SHIP), which offers free, unbiased help comparing your specific options.